Is commercially supported continuing medical education going to survive? Will commercial supporters and CME providers be able to maintain their "relationship" despite a constantly changing environment? Or is divorce inevitable?

At many of the major CME conferences—including the Alliance for CME Annual Meeting, MedEd Forum, CBI's CME Conference, and even the Global Alliance for Medical Education (GAME)—panel discussions, podium presentations, and hallway chatter gives way to discussions about what is needed to make the "marriage" work.

This happens even while the relationship itself appears to be very sound. Revenue from continuing medical education in 2006 was more than $2.3 billion, a 6 percent increase over the previous year, according to July's annual report from the Accreditation Council for Continuing Medical Education (ACCME). Still, that's less than the 9 percent growth of the year before and far less than the 15 percent of the year before that.

So what's the problem?

Despite growth and a common goal, the two groups face increasing federal scrutiny, tightening rules, and differing compliance regulations. The stakes for noncompliance for both companies and individuals are also frighteningly high. They can range from warning letters to criminal investigations to extremely high fines for damages under the False Claims Act.

CME providers come in many shapes and sizes. Medical schools are the bastion of academic providers, and for-profit medical-education companies are at the other end of the provider spectrum. Providers are tasked with designing, developing, and implementing CME activities. Last year, there were 729 ACCME-accredited providers, 13 more than the year before. And many of these providers are either reliant upon or benefit from receiving commercial support in order to function. Providers reported receiving $1.1 billion in commercial support, a 7.5 percent increase over 2005. The pharmaceutical industry provides, via grant programs, more than half that support—and last year, it continued to climb.

The interaction between providers and commercial sponsors has changed drastically over the years. In the past, more opportunities existed for necessary interaction between the groups; now, fear and conservatism overshadow the needs of each party to understand the other. In addition, no consistency exists between the sponsors with regards to policies.

Providers, small and large alike, must spend a great deal of time and effort, which also means money, trying to find the right method to submit the right grant request so that the right person eventually receives it.

Even when there is conversation between providers and supporters, it often boils down to those familiar phrases: "You never talk to me anymore";"I try to talk to you, but you don't seem to be listening"; and my favorite, "You're not hearing what I'm saying!"

Having moderated many panels on the topic of interaction between supporters and providers, I have found myself serving as a kind of marriage counselor. I've done it one-to-one, helping provider and supporter address their issues (think couples therapy), and with larger panels (à la group therapy).

More often than not, there is common ground. The same people responsible for marketing and promotion no longer award grants. But if you look at the pedigrees of those in charge of grants at the pharmaceutical companies, they are often more experienced in CME as both providers and supporters than their provider colleagues. I can think of at least half a dozen pharma CME leaders who have more than 15 years as providers and several who have FACME (Fellow of the Alliance for Continuing Medical Education) after their names.

And more often than not, there's true willingness to understand each other. I recall several sessions at which providers and supporters shared real concerns in the hopes of improving their relationships. At the Alliance for CME meeting not long ago, a CME provider stood up and asked a panel of commercial supporters why there needed to be so much pain involved in trying to get a grant. A wave of applause swept across the room.